Work

Acute acalculous cholecystitis and blackwater fever with acute kidney injury in children with malaria: case series and literature review

Year: 2026

Type: article

Abstract: BACKGROUND: Acute acalculous cholecystitis (AAC) is an inflammatory gallbladder disease occurring in the absence of gallstones. It typically presents with right upper quadrant (RUQ) pain, fever and gastrointestinal symptoms, and is diagnosed by ultrasound evidence of cholecystitis without gallstones. AAC can have multiple causes, including infections, with malaria only rarely reported. CASE PRESENTATIONS: We describe four Ugandan children who developed malaria-associated AAC. They were all referred from other centers and presented at a more advanced stage of disease. Apart from AAC, they also presented blackwater fever (BWF) and severe acute kidney injury (AKI), complications increasingly recognized in malaria. AAC was managed conservatively, while two patients required dialysis for kidney failure. All patients ultimately recovered both gallbladder and renal function. CONCLUSIONS: We provide a review of the literature on malaria-associated AAC, which identified 28 previously reported cases, only 7 in children. Most reported patients contracted the infection in malaria-endemic regions but were then managed in high-income countries. The majority were managed conservatively and had favorable outcomes. Including our series, 32 cases (11 pediatric) have now been reported. Our findings suggest that AAC, which can often occur in association with BWF and AKI, is likely underrecognized in malaria-endemic regions. Heightened clinical awareness and early assessment are important, and practical management recommendations are provided.

Source: Malaria Journal

DOI: 10.1186/s12936-026-06013-9

Authors: Marco Cugliari, Francesca Piacentini, Sara M. M. A. Montorfani, Obalim Fiddy, Sara Testa

Institutions: University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Florence, University of Fribourg, St. Mary's Hospital Lacor

Language: English

Topic: Gallbladder and Bile Duct Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,890